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Navy Military Treatment Facility and Veterans Administration Partnership, Skill Sustainment "Best Practice" for Hospital Corpsmen and Dentists Readiness

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By Lt. Cmdr. Renardis D. Banks, MSC, OIC, NBHC Fallon

Naval Health Clinic Lemoore (NHCL) and Veterans Affairs Sierra Nevada Health Care System (VASNHCS), Reno, partnered to establish a skills sustainment program for Naval Branch Health Clinic Fallon's (NBHCF) hospital corpsmen.

The program, established in November 2016, has proven to increase the skill level of general duty hospital corpsmen and was expanded in August 2018 to include specialty trained hospital corpsmen and dentists.
Hospital corpsmen are enlisted specialists in the U.S. Navy who serve in a variety of capacities and locations. They attend 14 weeks of basic medical technician hospital corpsman training in "A" School, which includes education on disease and pathology as well as emergency medical and nursing techniques. Select individuals can then go on to "C" School to receive specialized training in a variety of disciplines. Moreover, general duty hospital corpsmen serving at Marine Corps units receive specialized training in advanced emergency medicine and are often the sole caregivers within the unit. When deployed in austere environments, Marines entrust their health and lives to the hospital corpsman, their "Doc." The likelihood of hospital corpsmen stationed at outpatient branch clinics being exposed to emergency medicine situations is minimal or non-existent.

NBHCF is located on Naval Air Station Fallon (NASF), the premier air-to-air and air-to-ground training base for the Navy and home to Naval Aviation Warfighting Development Center (TOPGUN). NBHC Fallon is one of eight remote outpatient clinics in the Navy, and provides limited outpatient medical and dental care to beneficiaries. Due to the low complexity of the patients seen, hospital corpsmen and providers are not required to exercise complex skills learned in professional schools. Additionally, 65 percent of the clinic's staff have reported to the command straight out of the Navy's hospital corps school or residency programs.

Military Treatment Facilities (MTF) are often faced with identifying individuals for operational missions based on technical position, but not necessarily proficiency, which can threaten operational readiness. To mitigate this threat and ensure hospital corpsmen gain knowledge, skills and abilities necessary for operational assignments, NHCL partnered with VASNHCS.

The partnership provides practical training modalities to equip hospital corpsmen with the knowledge and skills necessary to make them more effective in triaging, assessing, and treating patients in humanitarian and combat environments. Since inception, twelve general duty hospital corpsmen have successfully completed training. The trainees undertake one month rotations and go through a comprehensive curriculum to include both instruction and hands-on experiences. The hospital corpsmen are under the supervision of registered nurses, one of which is a clinical educator. The MTF and Veterans Affairs (VA) staff are actively working together to continuously improve the program and ensure it is providing the best possible experience to train the general duty hospital corpsmen.

"This program began with many hours of planning and collaborating between NBHCF and VASNHCS," said Vonnie Doolin, registered nurse and one of the nurse educators with VASNHCS. "Initially, the first pair of corpsmen were assigned to VASNHCS Monday through Wednesday, every other week for approximately three months. During this time, the corpsmen were assigned for ten days to the medical surgical unit (MSU), one day to the peri-operative area, one day to wound care, and six days to the emergency department (ED)."

Doolin said that feedback from the departing corpsmen was used to adjust the orientation and rotations to best serve their requirements.
"Currently, the rotation is Monday through Friday for four weeks," added Doolin. "We did this to facilitate the corpsmen having consistent exposure to new and infrequently used skills and patient types for optimal skill acquisition. The rotation has evolved to five days in the MSU, three days in the In-Patient Mental Health Unit (MHU), seven days divided between peri-operative services and wound care, and seven days in the ED."

"The corpsmen are responsible for knowing their scope of practice, for being proactive participants in their learning and they are required to have a registered nurse co-signer for all documentation in the medical record," added Doolin.

"The staff and Veterans really enjoy having the corpsmen at our facility," said Doolin. "Nursing and nursing education staff meet with the corpsmen throughout the orientation to ensure learning needs are being met. We try to make sure they have a varied and productive learning experience with resources to assist them with skills they would need in the field."

Hospitalman Logan Griffith, NBHCF Medical Home Port team lead, participated in the program and this is what he has to say. "The training I received has given me confidence in training newly reported staff members. The Medical and Surgical Ward training I received has helped me be comfortable with patients because of the time spent in their continuation of care. Working in the ED is quick paced and has helped me be efficient here at the clinic with triage, blood draws, and Intravenous Therapy (IV)."

This year, the effectiveness of the training and experience received through VASNHCS training and skills sustainment program was tested. In one instance, a hospital corpsman deployed on USNS Mercy (T-AH 19) in support of Pacific Partnership 2018 and was awarded a Navy and Marine Corps Achievement Medal for her accomplishments as trauma team lead. Another hospital corpsman was sent to Navy Medicine's and Stroger Hospital Trauma Training Program and graduated first in her class.

"The training I received at Stroger Hospital was very similar to the training I received at Reno VA," said Hospital Corpsman 3rd Class Alexis Vanderwiele, a skills sustainment program participant and honor graduate of the Stroger Hospital Trauma Training Program. "I was able to recall my triage, IV, electrocardiogram (EKG) and wound care training, and experiences from Reno VA. I worked alongside Veterans in the emergency department, at both Reno, VA and Stroger Hospital, who I learned and benefitted from."

"Navy hospital corpsmen are at the forefront of Navy Medicine's mission to save lives wherever our warfighters operate, often independently, and require a high degree of skill and competency to ensure they are ready for any mission in any location," said Capt. Kristen Atterbury, NHCL commanding officer. "The corpsmen privileged to participate in this program receive invaluable hands-on experience in various clinical settings throughout the Reno, Nevada, VA hospital. We carefully select the corpsman for the program and each is honored to care for our nation's Veterans while they learn and hone the clinical skills needed to care for forward deployed Sailors and Marines."

After completing the program, said Atterbury, the corpsmen are confident, competent, and ready for any assignment in any setting.
"This is a model program that should serve as the example of how the strength of partnerships can contribute to improved clinical competency and readiness," added Atterbury. "We are proud of our strong partnership with the VA Sierra Nevada Health Care System and value the commitment they have made to train our hospital corpsman to provide the highest quality of care to Sailors and Marines around the globe."
All hospital corpsmen, regardless of specialty, are required to be knowledgeable in their basic skills in order to advance to the next rank. This is challenging for corpsmen who spend most of their day working in a specialized field who have to recall nursing techniques learned perhaps many years earlier at their initial training.

Dentists and dental technicians in outpatient settings receive little to no specialty dental experience because of the young, healthy population served. However, their VA counterparts provide more complex specialized dental care to Veteran patients because of the older population served. Conversely, active duty dentists are often highly trained in the use of computer-aided design and computer-aided manufacturing (CAD/CAM) and can use these skills to train VA dentists on the use of CAD/CAM equipment. Building upon an already successful program, NHCL and VASNHCS recently expanded the agreement to include specialized hospital corpsmen and dentists to further enhance the capabilities at both facilities.

"The training and care of our Navy's hospital corpsmen is of vital importance to the VA Sierra Nevada Health Care System," said Lisa Howard, VASNHCS director. "We know firsthand how the experience and training they earn now will carry them long into their future. Many of our staff started out as corpsmen themselves and when our Veterans see the corpsmen in their uniforms a sense of joy washes over them. Though the uniform has gone through many changes over the decades, the purpose and meaning behind it has remained the same. Our staff and Veterans are extremely proud to see the young men and women wear their uniform with such high honor. The VASNHCS is thankful to the corpsmen and Naval Health Clinic Lemoore for their hard work and generosity."


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